AIDS activists offered a critical
response to the first of an expected flurry of announcements from
pharmaceutical companies of amorphous or spurious drug donation
schemes. Yesterday, Boehringer Ingelheim released a statement
announcing a five-year nevirapine donation program (brand name:
Viramune) to developing countries for prevention of perinatal
transmission of HIV-1.

The release states that Boehringer
Ingelheim believes "that our initiative...will help make
an impact on the HIV/AIDS epidemic," but provides no structure
or timeline for implementation and no details for involvement
with participating governments -- common characteristics of drug
company announcements of donations, which ultimately offer very
little medication for very few people.

Further,
Boehringer Ingelheim acknowledges that "providing Viramune
is only one component of making prevention of HIV-1 mother to
child transmission possible in the developing world," but
refuses to offer affordable nevirapine as treatment for HIV infected
adults.

"Boehringer Ingelheim intends
to give pregnant women two doses of nevirapine and nothing more-when
there are treatments available that could extend their lives,"
said Joe West of ACT UP. "The only acceptable program must
provide a clear plan for treatment to women and other infected
family members, as well as assurance of medical follow up and
treatment for mothers and babies."

An announcement of a donation, with
no plan at all for providing for the care of the mother or child
is completely unethical. Multiple issues are not substantially
addressed, including informed consent, voluntary counseling and
HIV testing, and breastfeeding.

ACT UP offers no support for this
program unless and until acceptable responses are provided to
these concerns:

- Any ethical MCT prevention program
must be part of a comprehensive program for treatment of HIV positive
women, children, and other family members. Boehringer Ingelheim's
announcement makes no mention of the need to connect HIV prevention
in newborns to access to HIV treatment for adults, resulting in
countless needless deaths of both parents and orphans.

- As one of five participating companies
in the UNAIDS/Big Pharma 'partnership initiative,' Boehringer
Ingelheim has revealed the lack of coordinated effort from the
5 participating companies. Rather than providing a substantial
plan for improving nevirapine access for treatment--not only prevention--the
Boehringer Ingelheim announcement proves that the UNAIDS initiative
is nothing but smoke and mirrors that holds no significant promise
for any real provision of combination therapy.

- A donation scheme must not be
allowed to obscure efforts to increase access through means such
as compulsory licensing and parallel importing. Any country doing
generic production or importation of nevirapine must not be excluded
from this offer, if it is indeed genuine. "To save lives,
including those of children born to HIV positive mothers, we need
widespread access to combination therapy, requiring broad coordination
between companies," said Laura McTigue of Health GAP Coalition.
"They're not even talking to each other, they had their day
in the sun with their announcements, and they've all gone home.
Drug donation announcements are no substitute for verifiable and
sustainable public health measures to increase access."

"These announcements raise
the hopes of millions of people with HIV worldwide. When drugs
do not materialize, or programs are so small as to have virtually
no impact, people with AIDS are left with despair instead of treatment,"
said Julie Davids of ACT UP. "In addition, community leaders
in Kenya and Uganda have reported that the UNAIDS announcement
in May created tension between doctors and patients: people with
HIV and their families heard of rumored discounting but were still
unable to access medicine and concluded that local doctors were
getting free or cheap drugs but holding out at a higher price
to make a profit. "Announcements follow announcements and
each actor tries to keep its image clean but the reality of people
living with HIV/AIDS remains the same," said Gaelle Krikorian
of ACT UP Paris. "It is imperative for countries to find
their own solutions, by using generic medications produced by
national drug companies, by building up regional markets, and
by purchasing from suppliers that offer reasonable prices."

"HIV/AIDS drug prices will
be reduced by more than 85%". This announcement was made
by five of the biggest drug companies together with the United
Nations Joint Programme on AIDS (UNAIDS) and the World Bank. In
its release, UNAIDS was more cautious and claimed that "a
new dialogue has begun between five pharmaceutical companies and
United Nations organizations to explore ways to accelerate and
improve the provision of HIV/AIDS-related care and treatment in
developing countries". Should treatment activists in South
Africa and across the world welcome this announcement? Yes. But,
only with caution and scepticism.

Every 10 minutes a person with HIV/AIDS
in Southern Africa will die. These deaths are premature and unnecessary.
Why? Because there are medications that can and will keep adults
and children with HIV/AIDS alive, healthy and productive for many
years. Children are orphaned daily yet, with medicines their parents
can live to take care of them. Price and excessive profits by
drug companies denies poor people access to health. Activists
and health care workers are not alone in taking this stand. Last
week, James Wolfensohn, president of the World Bank told the Wall
Street Journal the leading US business newspaper: "With the
prices so high, there was little incentive for the governments
to build the health infrastructure to provide care". Real
price reductions will allow governments, international agencies,
the private sector and civil society to rapidly develop infrastructure
to provide treatment.

It is the responsibility of our
government to lead the struggle for price reductions and the development
of infrastructure to ensure that children and adults with HIV/AIDS
receive life-saving treatments. The South African government with
other African countries should set up a team to plan and negotiate
real drug price reductions, access to testing and monitoring equipment,
additional clinical and health care infrastructure support from
the UN, the World Bank and the drug companies. International public
opinion will support such action. Therefore, the drug companies
are trying to take control of the agenda. To ensure access to
HIV drugs for the majority of people, we must carefully assess
what they propose.

In a statement yesterday, Project
Inform, one of the oldest and most respected HIV/AIDS treatment
education organisations in the US identified "at least three
critical issues not clearly addressed in the public statements
made by the companies:

Do the price reductions come without
strings or are they conditional upon the participating country's
agreement to give up their rights to other treatment access mechanisms?
Does the proposed agreement cover only older, first generation
AIDS drugs or also the newer, more effective and easier-to-use
therapies? Will companies offer different discounts adjusted to the economic realities of individual
countries?" Drug companies must not be allowed to use the
United Nations to protect their excessive profits, or, to stop
governments from buying good quality generic equivalents at the
lowest possible price. The companies involved in this initiative
with the United Nations are Glaxo Wellcome, Bristol Meyers Squibb,
Roche, Merck and Boehringer Ingelheim "The Big Five".

The Nobel Prize-winning group Médecins
Sans Frontières (Doctors Without Borders) provided figures
to the South African Parliament last week. Between 1997 and 1999,
sales on two of the Glaxo Wellcome anti-Aids drugs - less production
costs, reached $694-million (about R4,858-billion) for AZT and
$1,453-billion (about R10-billion) for 3TC. Bristol Meyers Squibb
(BMS) made $379-million (about R2,653-billion) on ddI and $1,136-billion
(about R7,552-billion) for d4T. These are drugs that were mainly
developed by universities and the US government, therefore research
and development costs to the companies are minimal.

The same drugs AZT, 3TC, DDI and
D4T can be produced in Thailand, India, Brazil and Canada at lower
prices than the 85% price reductions on offer. But in Thailand,
Bristol Meyers Squibb has used every means possible to prevent
that government from making anti-HIV drugs available to its people.
Take Nevirapine (NVP) made by Boehringer Ingelheim a single dose
of this drug is particularly effective in preventing mother-to-child
transmission. It is also very cheap. But, its price can be reduced
by more than half through generic competition. Boehringer Ingelheim's
price is R32.26 and a good quality generic manufacturer in India
Cipla sells the same drug at less than R15.00. Doctors Without
Borders stated that "This agreement does nothing to stimulate
countries' rights to produce or import inexpensive quality drugs,
an important part of the long-term solution to improving access
to essential medicines."

But these are facts and figures.
They affect people with HIV/AIDS directly. Last week, the Treatment
Action Campaign (TAC) welcomed the UNAIDS and "Big Five"
announcement at Parliament but warned that drug companies should
not tie the hands of governments against finding the lowest possible
prices. It asked Parliament to provide data on the patents and
prices for all drugs to treat opportunistic infections and all
anti-retrovirals. So far, drug companies have only mentioned anti-retrovirals.

Christopher Monaka told the Parliamentary
Committee that he has thrush. Conradie Hospital did not have Diflucan
produced by Pfizer because of the costs. No other drug would help
his thrush. He spoke of the Pfizer campaign and explained that
while the donation for cryptococcal menigitis was welcome, people
with thrush were excluded. Health care workers frustrated at lack
of resources were not treating people with HIV/AIDS with dignity.
Christopher Monaka asked the government to ensure that Pfizer
reduce the price of Diflucan from R36.50 to less than R4.00 per
200mg capsule before 1 July 2000. "Every day many people
died because they do not have access to the drug."

Sindiswa Godwana said that she was
unemployed. She said the majority of people in South Africa were
poor and in the hospitals people with HIV were not even receiving
multivitamins. She gets them from her support group but most support
groups don't even have access to vitamins. She told the Parliamentary
Committee that they needed to ensure that opportunistic infections
were properly treated and anti-retroviral drugs were made available.
She argued that this would be possible if government forced drug
companies to lower their prices. "Why was the government
waiting?"

Fagmida Miller explained that she
was on a clinical trial. Her viral load was undetectable and her
health was good. This was the only way that she could get treated
for HIV. She asked the government to ensure that clinical trials
are properly conducted. Every adult and child with HIV/AIDS should
have access to treatment. No-one should be excluded because of
poverty or for any other reason.

The drug companies' announcement
shows that the effort of treatment activists in South Africa and
across the world has been necessary. But, success will depend
on further mobilisation. Therefore, the Treatment Action Campaign
(TAC) and HealthGap Coalition in the United States have won the
endorsement for a Global March for Treatment at the International
AIDS Conference in Durban on 9 July 2000 from Cosatu, Nactu, Fedusa,
Sangoco, Jubilee 2000 and many other organisations. The march
will be preceded by a joint conference of MSF and the TAC on improved
access to drugs in developing countries. Government must lead
on this issue. We all know the drug companies are profiteering
and that people die
because drug costs are too high. Criticism is not enough; leadership
and action from government will ensure that the announcement by
UNAIDS and the Big Five becomes a reality and that people in poor
countries receive HIV treatments.

Zackie Achmat the chairperson
of TAC has HIV and he refuses to take anti- retroviral medication
until it is available in the public sector. For information on
the conference or march contact: msf-tac@mweb.co.za
or (TAC) 031 3043673 or 011 403 0390.